Basic Information
Provider Information | |||||||||
NPI: | 1730418674 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | XUE FENG WANG, M.D., LTD. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | WESTERN STATES NEUROMONITORING ASSOCIATES | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 216 F ST # 76 | ||||||||
Address2: |   | ||||||||
City: | DAVIS | ||||||||
State: | CA | ||||||||
PostalCode: | 956164515 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5306688988 | ||||||||
FaxNumber: | 5306681229 | ||||||||
Practice Location | |||||||||
Address1: | 3860 GLEN ECHO COURT | ||||||||
Address2: |   | ||||||||
City: | RENO | ||||||||
State: | NV | ||||||||
PostalCode: | 89509 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5306688988 | ||||||||
FaxNumber: | 5306681229 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/23/2009 | ||||||||
LastUpdateDate: | 12/23/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WANG | ||||||||
AuthorizedOfficialFirstName: | XUE FENG | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICER/CEA | ||||||||
AuthorizedOfficialTelephone: | 5306688988 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 10778 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |   |
No ID Information.